HomeMy WebLinkAbout03-29-11 l J ~,S
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IN THE COURT OF COMMON PLEAS OF ~`L. ~
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CUMBERLAND COUNTY, PENNSYLVANI A' ~ ~ ~ ~'"~
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IN RE: MADELYN GOOD, a minor na
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No. 11-330 ~ c.,; `" ~
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AMENDED PETITION TO RELEASE FUNDS TO MINOR
Now comes Petitioner, Julie Good, parent and Natural guardian of Madelyn
Good, a minor, by and through her attorney, Jane Adams, Esq., and avers as follows:
Madelyn Good received an estate after the death of her Father on
November 8, 2004.
2. In accord with said estate, the funds were ordered to be placed in a Money
Market Account and not to be drawn upon except for the use of payment and
preparation of taxes regarding the estate until the minor, Madelyn Good, reaches the
age of i8. Attached hereto as `Exhibit A'
g. Madelyn Good will turn the age of i8 on June i, 2020.
4. The funds from this settlement are in a Money Market Account with Wells
Fargo in Fairview Heights, Illinois.
5. Madelyn Good has resided in Cumberland County, Pennsylvania since
May of 200.
6. Wells Fargo is now requiring that the jurisdiction of Madelyn Good's
estate be moved from Illinois to Pennsylvania in order to draw the account for the
use of payment and preparation of taxes.
~. Petitioner seeks to have the jurisdiction of the Madelyn Good's estate
moved from Illinois to Pennsylvania.
8. Petitioner seeks to have an order issued allowing the account to be drawn
for the use of payment and preparation of taxes.
g. Petitioner seeks to withdraw $3260.00 out of said account, in order for the
minor, Madelyn Good, to receive orthodontic treatment. Estimates for the orthodontic
treatment are attached as Exhibit "B".
io. Affidavit of the mother is attached and incorporated herein.
WHEREFORE, Petitioners ask this Honorable Court to enter an order releasing
said funds.
Respectfully submitted:
Date: ~ ~ C!
J Adams, Esquire
0. 79465
17JWest South Street
Aisle, Pa. 17013
ATTORNEY FOR PETITIONER
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THIRD JUDICIAL CIRCUIT ~ ~ .
MADISON COUNTY, ILLINOIS
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ORDER ,
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JOUfiNAi- PRIHTWCi - HI0HUIND, L 8?TAY
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MAR-11-2011 12:39 FROM: FRED J. ALGA DMD 717-795-0843 70:7172412456 P.1
C~ Smilce ehat,ChaaRe Ldvp
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116 Cumberland Parkway ~ (717) 697-6393
Mechanicsburg, PA 17055 admin~albeorthodontics.wm
it i n O.i!'a, i rr
/ur Chpchen and Adultr
Payment Options for Active Treatment
Patient Name: Madelyn Good
Treatment Fee:
Records Fee:
Total Fee:
$2,985.00
$275.00
$3,260.00
Date: 3/10/11
Treatrnenr Type: Phase 1
The orthodontic ke Includes all visits andproceduresperformedin our office over the estimotedlength of treatment This Jncludes
diagnostic records,appltancesnecessaryforactlve treaimentandretainers. Thefeeremainsunchangedregardlessofwhether
ireamenttokes more or less time than originally estimated, provided we are receiving the expectedamountofcooperation,
Ifappllonces need to be replaced due to loss, excessive breakage, misuse orcoreless handling, there will be a replacemenecharge.
Ourservlces maybe discontinued only due ro Jack ofcooperation, multiple failed appointments, or failure ro adhere ro the
flnanclal arrangements.
Option A: Payment in Fuli (Discount 9'6)
Treatment Fee: $3,260.00 Treatment Fee: 53,260.00
Less Cash/Check (5g6}; 516,E Less Credit Cd (3940: 59J~.4
Payment Due: 33,097.00 Payment Due: 53,162.20
Option B: Springstone Patient Financing
* No initial payment * Toll-free number is (800)-630-1663 or
~rww.aorinaatonaola n.com
* Take 12-48 months to pay (including a minimal finance charge)
* Rate and payments are fixed throughout the term of your loan
Option t: interest•Free Office
Treatment Fee:
Initial Payment Due:
Total Balance Due:
Balance paid in;
Monthly payment ofi
Payment Plan
$3,260.00
$9$Q,QQ (due at next appointment}
52,280.00
12 Months
5790.00 (due by the 1st of the month)
there are no finance, interest or service charges in connection
with the above office paymentplan.Monthly payments wilt be set up
by automatic deduction from Visa/Mastercord/
Debit card and electronic check Braking.
A late fee of 525.00 will be charged for Isla monthly payments.
!t is critical thatyou meet your Financial obligation.
If yourFinancial situation changes, we will be glad to
discuss reorranging yourpaymentschedule to fit your new
circumstance.
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IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
IN RE: MADELYN GOOD, a minor
No. 11-330
AFFIDAVIT
I, Julie Good, as the parent and natural guardian of Madelyn Good, a minor, do
believe and hereby affirm that the released funds from Wells Fargo will be used solely
for orthodontic treatment for the minor child, Madelyn Good. I believe it to be in the
child's best interest.
I verify that I am the petitioner and that the statements made in the foregoing Petition are
true and correct. I understand that false statements herein are made subject to the penalties of 18
Pa. C. S. § 4904, relating to unsworn falsification to authorities.
Julie Good